A Novel Inflammation-Based Prognostic Score: The Fibrinogen/Albumin Ratio Predicts Prognoses of Patients after Curative Resection for Hepatocellular Carcinoma

Abstract

Background: Inflammation is an important hallmark of cancer. Fibrinogen and albumin are both vital factors in systemic inflammation. This study investigated the prognostic value of the fibrinogen/albumin ratio in HCC patients who underwent curative resection.

Methods: HCC patients (n = 151) who underwent curative resection were evaluated retrospectively. The optimal cutoff value for the fibrinogen/albumin ratio was selected by receiver operating characteristic (ROC) curve analysis. Correlations between preoperative fibrinogen/albumin ratios and clinicopathologic characteristics were analyzed by χ² test. The area under the receiver operating characteristic curve (AUC) was calculated to compare the prognostic value of the fibrinogen/albumin ratio with other prognostic scores (neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and albumin-bilirubin (ALBI) score). The overall survival (OS) and time to recurrence (TTR) were assessed by the log-rank test and the Cox proportional hazard regression model.

Results: An optimal cutoff value of the preoperative fibrinogen/albumin ratio (0.062) was determined for 151 patients who underwent curative resection for HCC via a ROC curve analysis. Fibrinogen/albumin ratio > 0.062 was significantly associated with microvascular invasion, an advanced BCLC stage, and ALBI grade. Multivariate analyses revealed that fibrinogen/albumin ratio was an independent predictor for OS (P = 0.003) and TTR (P = 0.035). The prognostic ability of fibrinogen/albumin ratio was comparable to other prognostic scores (NLR, PLR, and ALBI score) by AUC analysis. Patients with a fibrinogen/albumin ratio > 0.062 had lower 1-, 3-, and 5-year OS rates (66.0%, 41.8%, and 28.2% versus 81.9%, 69.3%, and 56.1%, resp., P < 0.001) and higher 1-, 3-, and 5-year recurrence rates (60.9%, 79.2%, and 90.5% versus 49.5%, 69.1%, and 77.1%, resp., P = 0.008) compared with patients with fibrinogen/albumin ratio ≤ 0.062.

Conclusion: The preoperative fibrinogen/albumin ratio is an effective prognostic factor for HCC patients who underwent curative resection. An elevated fibrinogen/albumin ratio significantly correlates with poorer survival and a higher risk of recurrence in HCC patients.

Figure 1

Determination of the cutoff value for the Fib/Alb ratio in patients undergoing curative resection for HCC by ROC analysis.

Figure 2

Comparison of the areas under the curves for the Fib/Alb ratio, NLR, PLR, ALBI grade, and other clinical indexes. The discrimination ability of the Fib/Alb ratio, NLR, PLR, ALBI grade, and other clinical indexes was compared by the AUC for OS.

Figure 3

Kaplan–Meier curves of overall survival and recurrence are shown for HCC patients. (a) OS of patients with a Fib/Alb ratio > 0.062 was significantly shorter than that of those with a Fib/Alb ratio ≤ 0.062 (P < 0.001, log-rank test). (b) Recurrence rate of patients with a Fib/Alb ratio > 0.062 was significantly higher than that of those with a Fib/Alb ratio ≤ 0.062 (P = 0.0081, log-rank test).

Figure 4

Kaplan–Meier survival curves of HCC patients without microvascular invasion. Fib/Alb ratio > 0.062 was significantly correlated with a shorter OS (a) and higher recurrence rate (b).